Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial

Ford, Jon; Hahne, Andrew J.; Surkitt, Luke D.; Chan, Alexander Y.P.; Richards, M.; Slater, Sarah L.; Hinman, Rana S; Pizzari, Tania; Davidson, Megan; Taylor, Nicholas F.

doi:10.1136/bjsports-2015-095058

Cited by 34 publications

(27 citation statements)

References 44 publications

(51 reference statements)

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“…General strength and conditioning [24,25] and motor control exercise with adjunct spinal manipulative therapy [26] are commonly implemented clinical modalities that have been extensively studied for pain intensity. However, less is known about how these interventions can impact additional outcomes in CLBP [13].…”

Section: Introductionmentioning

confidence: 99%

Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes

Tagliaferri

Miller

Ford

et al. 2020

JCM

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Exercise and spinal manipulative therapy are commonly used for the treatment of chronic low back pain (CLBP) in Australia. Reduction in pain intensity is a common outcome; however, it is only one measure of intervention efficacy in clinical practice. Therefore, we evaluated the effectiveness of two common clinical interventions on physical and self-report measures in CLBP. Participants were randomized to a 6-month intervention of general strength and conditioning (GSC; n = 20; up to 52 sessions) or motor control exercise plus manual therapy (MCMT; n = 20; up to 12 sessions). Pain intensity was measured at baseline and fortnightly throughout the intervention. Trunk extension and flexion endurance, leg muscle strength and endurance, paraspinal muscle volume, cardio-respiratory fitness and self-report measures of kinesiophobia, disability and quality of life were assessed at baseline and 3- and 6-month follow-up. Pain intensity differed favoring MCMT between-groups at week 14 and 16 of treatment (both, p = 0.003), but not at 6-month follow-up. Both GSC (mean change (95%CI): −10.7 (−18.7, −2.8) mm; p = 0.008) and MCMT (−19.2 (−28.1, −10.3) mm; p < 0.001) had within-group reductions in pain intensity at six months, but did not achieve clinically meaningful thresholds (20mm) within- or between-group. At 6-month follow-up, GSC increased trunk extension (mean difference (95% CI): 81.8 (34.8, 128.8) s; p = 0.004) and flexion endurance (51.5 (20.5, 82.6) s; p = 0.004), as well as leg muscle strength (24.7 (3.4, 46.0) kg; p = 0.001) and endurance (9.1 (1.7, 16.4) reps; p = 0.015) compared to MCMT. GSC reduced disability (−5.7 (−11.2, −0.2) pts; p = 0.041) and kinesiophobia (−6.6 (−9.9, −3.2) pts; p < 0.001) compared to MCMT at 6-month follow-up. Multifidus volume increased within-group for GSC (p = 0.003), but not MCMT or between-groups. No other between-group changes were observed at six months. Overall, GSC improved trunk endurance, leg muscle strength and endurance, self-report disability and kinesiophobia compared to MCMT at six months. These results show that GSC may provide a more diverse range of treatment effects compared to MCMT.

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Section: Introductionmentioning

confidence: 99%

Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes

Tagliaferri

Miller

Ford

et al. 2020

JCM

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“…Participants randomised to the MCMT group will receive twelve 30-min one-on-one physiotherapy sessions, consistent with previous protocols in chronic low back pain care [ 57 , 58 ]. In the first 3 months ten sessions (one to two sessions a week) will be delivered with two sessions in the final 3 months.…”

Section: Methodsmentioning

confidence: 99%

Optimising conservative management of chronic low back pain: study protocol for a randomised controlled trial

Simson

Miller

Ford³

et al. 2017

Trials

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BackgroundLower back pain is a global health issue affecting approximately 80% of people at some stage in their life. The current literature suggests that any exercise is beneficial for reducing back pain. However, as pain is a subjective evaluation and physical deficits are evident in low back pain, using it as the sole outcome measure to evaluate superiority of an exercise protocol for low back pain treatment is insufficient. The overarching goal of the current clinical trial is to implement two common, conservative intervention approaches and examine their impact on deficits in chronic low back pain.Methods/designForty participants, 25–45 years old with chronic (>3 months), non-specific low back pain will be recruited. Participants will be randomised to receive either motor control and manual therapy (n = 20) or general strength and conditioning (n = 20) exercise treatments for 6 months. The motor control/manual therapy group will receive twelve 30-min sessions, ten in the first 3 months (one or two per week) and two in the last 3 months. The general exercise group will attend two 1-hour sessions weekly for 3 months, and one or two a week for the following 3 months. Primary outcome measures are average lumbar spine intervertebral disc T2 relaxation time and changes in thickness of the transversus abdominis muscle on a leg lift using magnetic resonance imaging (MRI). Secondary outcomes include muscle size and fat content, vertebral body fat content, intervertebral disc morphology and water diffusion measured by MRI, body composition using dual energy X-ray absorptiometry, physical function through functional tests, changes in corticospinal excitability and cortical motor representation of the spinal muscles using transcranial magnetic stimulation and self-reported measure of pain symptoms, health and disability. Outcome measures will be conducted at baseline, at the 3-month follow-up and at 6 months at the end of intervention. Pain, depressive symptomology and emotions will be captured fortnightly by questionnaires.DiscussionChronic low back pain is ranked the highest disabling disorder in Australia. The findings of this study will inform clinical practice guidelines to assist with decision-making approaches where outcomes beyond pain are sought for adults with chronic low back pain.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12615001270505. Registered on 20 November 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1913-8) contains supplementary material, which is available to authorized users.

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“…From a traditional manual therapy perspective manual therapy should, hypothetically, be most beneficial for peoples with relatively uncomplicated multidimensional profiles, where a dominant peripheral source of nociception to which manual therapy could be directed exists, such as cases 2 and 5. Indeed, case 2 may respond to manual therapy in the short-term, since there is some preliminary, low-quality evidence to suggest that when subgroups of likely responders to manual therapy are targeted with manual therapy they exhibit better treatment outcomes (Ford et al , 2016, Haskins et al , 2015, Slater et al , 2012. Previously published clinical prediction rules on responders to manipulative therapy, have identified similar uncomplicated patient profiles (Flynn et al , 2002, Fritz et al , 2005, however, two issues are notable.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Reconceptualising manual therapy skills in contemporary practice

Rabey¹,

Hall

Hebron

et al. 2017

Musculoskeletal Science and Practice

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With conflicting evidence regarding the effectiveness of manual therapy calls have arisen within some quarters of the physiotherapy profession challenging the continued use of manual skills for assessment and treatment. A reconceptualisation of the importance of manual examination findings is put forward, based upon a contemporary understanding of pain science, rather than considering these skills only in terms of how they should "guide" manual therapy interventions. The place for manual examination findings within complex, multidimensional presentations is considered using vignettes describing the presentations of five people with low back pain. As part of multidimensional, individualised management, the balance of evidence relating to the effectiveness, mechanisms of action and rationale for manual skills is discussed. It is concluded that if manual examination and therapeutic skills are used in a manner consistent with a contemporary understanding of pain science, multidimensional patient profiles and a person-centred approach, their selective and judicious use still has an important role.

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Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial

Abstract: ACTRN12609000834257.

Cited by 34 publications

References 44 publications

Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes

Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes

Optimising conservative management of chronic low back pain: study protocol for a randomised controlled trial

Reconceptualising manual therapy skills in contemporary practice

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